Evidence Based Medicine in an Era of Post-Truth and Alternative Facts

Kevin Powell, MD PhD, Physician, St. Louis, MO

Medicine and religion share a key foundation – the search for knowledge or, as some define it, for justified belief. While the goals are not exactly aligned, the processes each institution uses to seek and validate truth are similar enough to draw analogies and learn from each other’s weaknesses and strengths, and the consequent successes and failures.

Medical research has encountered a replicability crisis. Too much of what we thought we knew is proving to be false. Too much of recently published medical research fails when other scientists try to replicate it. While theologians are accustomed to dealing the doubt, the philosophy of science presumes a high degree of certainty in scientific laws.

Rene Descartes’ famous response (Cogito ergo sum.) to a similar crisis was to seek to reinvent philosophy relying only on inferences he knew to be absolutely true. Medicine has embarked on a similar campaign. The dogmas of the past are being challenged or discarded. The work of bench scientists is being discounted. The opinions of an expert panel carry little weight. Evidence based medicine, (EBM) a term coined 25 years ago, hopes that relying almost exclusively on the meta-analysis of randomized control trials will ultimately produce a rigorously purified knowledge base, such as the Cochrane Library.

A key element is utilizing the appropriate amount of doubt. The testimonials of faith healing are rejected when the scientific skepticism is insufficient. Conversely, EBM’s emphasis solely on statistical analysis, to the exclusion of scientific principles, has not produced the robust and reliable knowledge it promised. In my paper, I will explain some of the causes of this shortfall, citing multiple examples.

Meanwhile, the public’s perception of truth has changed. We have entered a world of post-truth. Postmodern thinking is morphing into a transhuman era. Where I once, as a doctor, examined a newborn and proclaimed her to be a healthy girl, now multiple machines must certify the baby to be healthy before it can be discharged from the nursery. Similarly, a touchdown in football isn’t real until instant replay has reviewed it.

The tolerance for scientific error has also changed. Medical knowledge has evolved via a series of refinements over time. But now any imperfection in science can form the basis of accusations used by those who deny climate change or preach vaccine hesitancy.

EBM is not achieving its goal of reliable knowledge. It can gain insight from parallels in the field of philosophy.